Acceleration Time and Ratio of Acceleration Time to Ejection Time in Aortic Stenosis: New Echocardiographic Diagnostic Parameters

Gamaza-Chulián, Sergio; Díaz‐Retamino, Enrique; Freire, Santiago Jesús Camacho; Ruiz-Fernández, Dolores; Gutiérrez-Barrios, Alejandro; Oneto-Otero, Jesús

doi:10.1016/j.echo.2017.06.001

Cited by 49 publications

(35 citation statements)

References 28 publications

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“…The current findings are similar to observations made in patients with AS, with several studies reporting an increased AT in severe AS [4][5][6][7]. Mean AT values are generally lower in these patients.…”

Section: Discussionsupporting

confidence: 90%

“…A potential explanation lies in the assessment of acceleration time (AT), defined as the interval between the onset of ejection flow and the peak velocity (PV), which has been tested in a variety of clinical settings [4][5][6][7][8][9]. Previous studies in patients with aortic stenosis (AS) have demonstrated that an increase in stenosis severity leads to increased AT [4][5][6][7]. The aim of this study is to assess the relation between clinical characteristics and echocardiographic measurements, including AT and symptoms in obstructive HCM patients.…”

Section: Introductionmentioning

confidence: 99%

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Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

et al. 2020

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Aims Not all obstructive hypertrophic cardiomyopathy (HCM) patients are symptomatic. The relation between obstructive HCM and symptoms is not well understood. The hypothesis of this study is that left-ventricular outflow tract (LVOT) acceleration time (AT) is associated with symptoms. Methods We included 187 patients (61% men, mean age 55 ± 14 years) with obstructive HCM, defined as a maximal wall thickness ≥ 15 mm and a resting or provoked LVOT peak gradient ≥ 30 mmHg. Peak velocity (PV), left-ventricular (LV) ejection time (ET), and AT (the time between LVOT flow onset and the moment of PV) were measured on continuous-wave (CW) Doppler tracings. Logistic and Cox proportional hazard regression analyses were used to evaluate the relation between symptoms [New York Heart Association (NYHA) class ≥ II] and echocardiographic measurements, including AT. Reproducibility was assessed using the intraclass correlation coefficient (ICC). Results Symptomatic patients were more often female and had higher mean AT values. Logistic regression demonstrated a significant association between AT and symptomatic status (odds ratio 1.31 per 10 ms, p < 0.01) after adjustment for sex, negative inotropes, PV, LVOT diameter, and diastolic dysfunction. AT was independently associated with symptoms and septal reduction during follow-up (hazard ratio 1.09 per 10 ms, p < 0.05). The ICC was 0.98 with a mean difference of 0.28 ± 8.4 ms. Conclusion In obstructive HCM patients, increased AT is significantly related to symptoms after adjustment for sex, negative inotropes, PV, LVOT diameter, and diastolic dysfunction, and is associated with the symptomatic status during follow-up. AT represents an easily measured echocardiographic variable with excellent inter-reader reproducibility.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

et al. 2020

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“…The delay in aortic pressure upstroke, which can be detected on palpitation as pulsus tardus et parvus, slow rising, and late peaking pulse, has been reported in several prior studies. 2,3,10,11 Worsening severity of AS increases the velocity across the stenotic valve, along with prolongation of ET, causing delay in reaching the maximal velocity across the valve that could be detected by carotidography, phonocardiography, and echocardiography. 2,3,15,16 Although these prolongations in AV peak velocity are highly affected by cardiac function or heart rate, time to the maximal velocity of the AV flow is not sufficient as a surrogate of AS severity, especially in LGAS.…”

Section: Hemodynamic Profile To Detect True Severe Asmentioning

confidence: 99%

Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve

et al. 2019

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Diagnosis of low-gradient severe aortic stenosis (AS) is challenging. We hypothesized that the time between left ventricular (LV) and aortic systolic pressure peaks (T LV-Ao) is associated with aortic stenosis (AS) severity and may have additive value in diagnosing severe AS, especially in patients with low-gradient AS. OBJECTIVE To investigate the diagnostic utility of measuring catheter-based T LV-Ao in patients with severe AS. DESIGN, SETTING, AND PARTICIPANTS We studied 123 patients with severe AS at the Cleveland Clinic Foundation, a tertiary referral center, who underwent transcatheter aortic valve replacement (TAVR) via femoral access and had pre-TAVR cardiac computed tomography assessment and hemodynamic measurements recorded during a TAVR procedure. All patients received hemodynamic evaluation, echocardiographic assessment, and quantification of aortic valve calcification (AVC) by multidetector computed tomography. Hemodynamic data were collected via left heart catheterization done just before TAVR, and T LV-Ao was calculated offline. Data were analyzed between October 5, 2015, and July 20, 2016. MAIN OUTCOMES AND MEASURES The association between T LV-Ao and AVC or other conventional imaging parameters was analyzed. RESULTS Of the included patients, the mean (SD) age was 81 (9) years, and 65 (54%) were men (54%). Among 123 patients, 48 patients (39%) had low-gradient AS (<40 mm Hg) and mean (SD) T LV-Ao was 69 (39) milliseconds. In multivariable logistic regression analyses, higher T LV-Ao (odds ratio [OR], 1.02; 95% CI, 1.01-1.04; P = .002) and higher peak aortic valve (AV) velocity (OR, 1.01; 95% CI, 1.00-1.02; P = .008) were independently associated with severe AVC (AVC >1000 AU). Adding T LV-Ao to the peak AV velocity and AV area showed significant incremental value to be associated with AVC, with a net reclassification improvement of 0.61 (95% CI, 0.23-0.99; P = .002) and integrated discriminatory improvement of 0.09 (95% CI, 0.03-0.16; P = .003). In a subgroup of patients with low-grade AS, higher T LV-Ao was the only parameter associated with severe AVC (OR, 1.02; 95% CI, 1.001-1.04; P = .03). CONCLUSIONS AND RELEVANCE Prolonged T LV-Ao was associated with severe AVC. This catheter-based hemodynamic index may be an additional surrogate to differentiate low-gradient true severe AS. Larger, prospective studies investigating the role of T LV-Ao as a marker of clinical outcomes in patients undergoing TAVR are required.

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“…In moderate or worse degrees of valvular AS, an AT:ET >0.35 identified symptomatic AS (sensitivity 77%, specificity 100%) and was associated with higher serum NT-proBNP levels [57]. The same optimal AT:ET cut-off of !0.35 was also able to reasonably differentiate severe AS from mild or moderate disease (sensitivity 59%, specificity 86%) in a larger cohort of patients [58]. Prolongation of the AT and an AT: ET >0.36 has been demonstrated to predict severe AS and is prognostically associated with increased mortality or need for AVR [59,60].…”

Section: Acceleration Time/ejection Time (At/et) Ratiomentioning

confidence: 98%

Contemporary Imaging of Aortic Stenosis

Chong

Senior

Wahi

2019

Heart, Lung and Circulation

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Acceleration Time and Ratio of Acceleration Time to Ejection Time in Aortic Stenosis: New Echocardiographic Diagnostic Parameters

Cited by 49 publications

References 28 publications

Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

Left-ventricular outflow tract acceleration time is associated with symptoms in patients with obstructive hypertrophic cardiomyopathy

Association of Time Between Left Ventricular and Aortic Systolic Pressure Peaks With Severity of Aortic Stenosis and Calcification of Aortic Valve

Contemporary Imaging of Aortic Stenosis

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